title: Does unilateral laparoscopic diathermy adjusted to ovarian volume increase the chances of ovulation in women with polycystic ovary syndrome?
abstract: OBJECTIVE
  Does unilateral volume-adjusted laparoscopic diathermy increase the chances of ovulation in women with polycystic ovary syndrome (PCOS)?
  
  
  CONCLUSIONS
  Although unilateral laparoscopic ovarian drilling (ULOD) using adjusted thermal doses was more efficient than bilateral laparoscopic ovarian drilling (BLOD) using fixed doses, the chances of ovulation were improved in patients irrespective of the technique used.
  
  
  BACKGROUND
  The adjustment of the thermal dose to ovarian volume in BLOD increases ovulation and pregnancy rates compared with fixed-dose treatment, but BLOD causes the formation of adhesions, particularly on the left ovary, and increases the risk of damage to ovarian tissue. In contrast, ULOD with a fixed thermal dose minimizes the risk of ovarian tissue damage, and can increase the activity in both right and left ovaries, although this varies in humans and in other species.
  
  
  METHODS
  This prospective, longitudinal, study, between September 2009 and January 2013, included 96 infertile women with PCOS who were unresponsive to clomiphene citrate treatment and had underwent either ULOD or BLOD. After surgery, the groups were followed up for 6 months to assess ovulatory response.
  
  
  METHODS
  Patients were assigned to two groups; one group underwent laparoscopic ovarian drilling of the right ovary alone, while both ovaries were treated in the second group. The ULOD group (n = 49) received thermal doses adjusted to the volume of the right ovary (60 J/cm³). The BLOD group (n = 47) received fixed doses of 600 J per ovary, regardless of its volume. The two treatment groups were matched by the number of participants, age and baseline parameters.
  
  
  RESULTS
  The ovulation rate during the first menstrual cycle after LOD was significantly higher in the ULOD group than in the BLOD group [73 versus 49%; absolute risk reduction (ARR), -0.25; 95% confidence interval (CI), -0.44 to -0.03; P = 0.014]. Treatment with ULOD on the right ovary significantly increased the chances of ovulation in patients with a larger right ovary compared with those who had a smaller right ovary (100 versus 36%; ARR, -0.64; 95% CI, -0.84 to -0.37; P = 0.004). Interestingly, the chances of ovulation were also significantly higher in patients in the BLOD group who had a larger right ovary compared with those who had a smaller right ovary (88 versus 33%; ARR, -0.55; 95% CI, -0.73 to -0.28; P = 0.002). The pregnancy rate was also significantly higher in patients with a larger right ovary compared with those with a smaller right ovary, regardless of the treatment group.
  
  
  CONCLUSIONS
  The 6-month follow-up was too short to demonstrate any long-term differences in the ovulation rates. Future research should therefore extend the follow-up beyond 6 months. Another limitation is that ULOD was used to treat only the right ovary. Future studies should investigate whether ULOD treatment of the larger ovary, whether left or right, would significantly increase the ovulation rate.
  
  
  CONCLUSIONS
  This study represents an advance in the determination of the optimal laparoscopic treatment for women with PCOS, as it was shown that improved results can be achieved using less thermal energy in volume-adjusted ULOD.
authors.affiliation: Department of Obstetrics and Gynecology, University of Split, Split University Medical Centre, Split, Croatia.
authors.forename: M
authors.initials: M
authors.lastname: Sunj
authors.forename: T
authors.initials: T
authors.lastname: Canic
authors.forename: D P
authors.initials: DP
authors.lastname: Baldani
authors.forename: M
authors.initials: M
authors.lastname: Tandara
authors.forename: A
authors.initials: A
authors.lastname: Jeroncic
authors.forename: I
authors.initials: I
authors.lastname: Palada
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D015331:Cohort Studies; D017523:Croatia / Q000453:epidemiology; D003972:Diathermy / Q000009:adverse effects; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects; D008137:Longitudinal Studies; D009929:Organ Size; D059351:Organ Sparing Treatments / Q000009:adverse effects; D010053:Ovary / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D010060:Ovulation; D011085:Polycystic Ovary Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D018873:Pregnancy Rate; D061685:Time-to-Pregnancy; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control; D014463:Ultrasonography
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene
keywords: laparoscopic ovarian diathermy; ovary volume; ovulation; polycystic ovary syndrome; side of the ovary